Donuts
The department made up of clinical staff that review prior authorization requests and claims for medical necessity.
What is Healthcare Services (HCS)?
The network used for Connect members.
What is the neighborhood network?
The way a direct individual member updates their address with PHP.
What is submit a written notice to Membership Accounting? (mail or email)
The type of plan that only has in-network benefits.
What is the Personal Option Plan?
The network used for a member with in-network benefits in Alberton, Montana?
What is the FCHN network?
The KMS topic that houses directions on how to order an ID card.
What is the "ID Cards and Member Materials" topic?
Whether or not Choice members have access to national networks (in-network benefits outside of Oregon/SW WA).
What is no?
The labs that are considered preventive for adults and therefore CIF for members on plans that have taken on the reform.
What are: Cholesterol Screening, Diabetes Screening, Hep C Virus Screening (for adults born between 1945-1965), HIV Screening and Counseling, and Syphilis Screening.
The KMS topic that houses information on infertility benefits.
What is the Pregnancy topic?
The type of plan that MBR ID 112941351-00 is on.
BONUS: Did this member purchase their plan through the FFM or Providence directly?
What is a connect plan?
BONUS: Individual direct
Using MBR ID 100858835-00 the provider directory or Facets, tell me whether or not Dr. Scott Alexander, in Klamath Falls (zip 97601) practices out of a medical home or not.
What is yes?
BONUS Bragging Points: What's the name of the medical home?
The name of the only UC facility located within 5 miles of zip code 97006 for a prospective individual choice member.
What is Providence Medical Group - Tanasbourne Immediate Care?
The type of federal subsidy that reduces the amount that members pay for their premium, and what members specifically it applies to.
What is APTC - Advance Premium Tax Credit?
Who are FFM individual members?
This is when a dependent makes a verbal request when they feel endangered or threatened and want their protected health information be sent to a different address instead of the subscriber's address.
What is Confidential Communication: Endangerment?
The place a prospective member can find information about premium rates for our individual plans.
What is the PHP external website?
BONUS Bragging Points: If the rep can pull it up online!
Whether or not consent is on file for Tammy Demezas Peneyra to speak about her husband's account under MBR ID 113299898-00 (Stephen Peneyra).
BONUS Bragging Points: If on file, what date does it expire?
What is yes?
BONUS Bragging Points: Expires 01/07/2021
Whether or not a member would be responsible for any cost share amount for the ER room if their individual cost share limit has been met for that year?
What is no?
The department made up of 3 subsections that is responsible for making sure PHP is not paying out more than we need to on claims.
BONUS: Can you list the three sub departments?
What is OFT (Operations Financial Transactions)?
BONUS ANSWER: What is COP, TPL and Refunds
The network used for a member with national network benefits and seeking care in Parker, Pennsylvania?
What is First Health?
The name of the one Spanish speaking orthopedic surgeon listed within 5 miles of zip code 97216 for MBR ID 100185415-00.
Who is Gavin Button?
Denise's favorite kind of food.
What are donuts?
Using MBR ID 113244162-00, tell me whether or not Dr. Robert Byerly can be a covering provider for Dr. Mustaquim Chowdhury.
What is yes?
Provider TIN and specialties match. Both providers work out of Hillsboro Internal Medicine Clinic.
The way a FFM individual member updates their address with PHP.
What is contact the FFM by phone or online at healthcare.gov?
***BONUS: What do they need to make it in order for it to come over on the file from FFM?
The length of time written consent is valid for.
What is 24 months from the date that it is signed? (Unless otherwise stated on the form)
The pin # for MBR ID 113129827-00.
What is 5360?